Positional Relationship between Two Microcatheters according to the Navigation Sequence within the Curved Vessel in...

Area of Science:

• Neurosurgery
• Interventional Radiology
• Vascular Anatomy

Background:

• Neuroendovascular treatment frequently involves navigating multiple microcatheters within complex intracranial vasculature.
• Understanding the spatial relationship between these catheters is critical for procedural success and patient safety.

Purpose of the Study:

• To investigate the positional relationship between two microcatheters based on their guiding order in simulated intracranial blood vessels.
• To test the hypothesis that the first guided catheter occupies an inner lumen path and the second, an outer path in curved vessels.

Main Methods:

• In vitro experiments using a silicone vascular model simulating a bent blood vessel (paraclinoid region).
• Utilized a microcatheter and a balloon catheter to replicate the guiding process.
• Observed catheter positioning based on the sequence of insertion.

Main Results:

• Experimental results confirmed the hypothesis: the first guided catheter consistently took an inner path, while the subsequently guided catheter occupied an outer path.
• This positional relationship was also observed during actual clinical procedures, specifically balloon-assisted coil embolization.

Conclusions:

• The navigation order of microcatheters significantly influences their final positional relationship within intracranial vessels.
• This finding is particularly relevant for complex neuroendovascular techniques such as balloon-assisted coiling and stent-assisted coiling with jailed microcatheters.